In recent years, rotator cuff suture passers have become commonly used during arthroscopic surgical procedures. For many types of repairs, the surgeon needs to arthroscopically pass sutures—often many—through soft tissues that have become detached from bone. These passers have made it quick and easy to pass suture through tissue. However, large repairs can often require many suture passes, especially if a secure hold on the tissue is required, leading to difficult suture management issues.
As noted above, there are currently many suture passers on the market designed to pass suture through soft tissue. These passers typically comprise an articulating jaw on the end of a shaft that can be passed through a cannula (if used in an arthroscopic procedure) and used to grasp tissue where the suture is going to be passed. The surgeon squeezes the handle to advance a flexible suture needle (with the suture attached) from the bottom jaw, up through the tissue, and through the top jaw. When the needle is retracted, a loop of suture is left on the top of the tissue. This loop can be retrieved using a suture grasper, leaving a simple stitch through the tissue. More recently, “grasp-and-retrieve” suture passer designs have been developed. These passers have a trap door or other suture catching mechanism in the top jaw. When the suture needle and suture are passed up through the tissue and the passer top jaw, the loop is captured by this catching mechanism. When the suture passer is pulled out of the cannula and joint space, the suture end loop is pulled out with it, eliminating the step of retrieving the suture loop with the grasper. This feature can be very useful in areas of poor visibility or if the surgeon does not have a hand available (because one is holding the arthroscope and the other is holding the suture passer). The passed suture can then be loaded into a knotless suture anchor, passed through additional tissue, or tied to other sutures to approximate and secure tissue to bone.
The current tools work well to pass a simple stitch through flat tissue, such as the rotator cuff tendons. However, a simple stitch through tissue is not as secure as other types of stitches, such as a mattress or Mason-Allen stitch. Also, as the sutures are passed through the tissue multiple times to create more secure stitches, suture management can become difficult, requiring a high degree of surgeon skill or increasing the duration of the procedure.